Department of Radiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
Ann Vasc Surg. 2022 Mar;80:264-272. doi: 10.1016/j.avsg.2021.08.052. Epub 2021 Nov 5.
Endotension is one of the detrimental complications after endovascular aneurysm repair (EVAR) and surgical management has been considered as standard of care. However, there is a paucity of data regarding the findings, and outcomes of such surgical intervention. The aim of this study was to investigate intraoperative findings and outcomes of surgical treatment for endotension after EVAR.
Between January 2005 and October 2018, of the 708 patients who underwent EVAR for aneurysm aortic aneurysm; 12 patients (mean age of 76.1; range 66-88) who underwent open repair for endotension were retrospectively analyzed. The anatomical characteristics of the aorta and surgical findings were reviewed. The rates of early and late procedural complications, and overall mortality were evaluated.
The median interval between the EVAR and surgical conversion was 45.9 months (range 17.1-46.9). Three of the twelve patients underwent emergency surgery due to aneurysm rupture. The median aneurysm sac size, the proximal neck diameter, and the proximal neck length before EVAR were 64 mm, 23.5 mm, and 30.5 mm, respectively, that changed before open repair to 93.5 mm (P = 0.02), 25 mm (P = 0.011), and 23 mm (P = 0.003), respectively. In four of the twelve patients, radiographically undetected endoleak was identified during surgery to be Type Ia, Ib, II, and III, respectively. The rates of early and late procedural complications, and overall mortality were 8.3%, 8.3% and 8.3%, respectively.
Patients with endotension have a risk of delayed endoleak and aneurysm rupture; secondary intervention should be performed in such cases to prevent fatal complications. Surgical treatment appears to be a curative treatment for endotension with favorable outcomes. In addition, the possibility of an undetected endoleak should be considered as a potential cause of endotension.
血管内动脉瘤修复（EVAR）后发生的内张力是一种有害的并发症，手术治疗已被认为是标准的治疗方法。然而，关于这种手术干预的发现和结果的数据很少。本研究的目的是探讨 EVAR 后内张力的手术治疗的术中发现和结果。
2005 年 1 月至 2018 年 10 月，708 例接受腹主动脉瘤 EVAR 的患者中，12 例（平均年龄 76.1 岁；范围 66-88 岁）因内张力而行开放修复，回顾性分析。回顾性分析了主动脉的解剖特征和手术发现。评估了早期和晚期手术并发症的发生率和总死亡率。
EVAR 与手术转换之间的中位间隔时间为 45.9 个月（范围 17.1-46.9）。12 例患者中有 3 例因动脉瘤破裂而行急诊手术。12 例患者中，在 EVAR 前，中位瘤腔直径、近端颈部直径和近端颈部长度分别为 64mm、23.5mm 和 30.5mm，在开放修复前分别为 93.5mm（P=0.02）、25mm（P=0.011）和 23mm（P=0.003）。在 12 例患者中，有 4 例在术中发现影像学未检测到的内漏分别为Ⅰa、Ⅰb、Ⅱ和Ⅲ型。早期和晚期手术并发症的发生率和总死亡率分别为 8.3%、8.3%和 8.3%。
内张力患者有迟发性内漏和动脉瘤破裂的风险；应在这种情况下进行二次干预，以防止致命并发症。手术治疗似乎是治疗内张力的一种有疗效的方法，且结果良好。此外，应考虑未检测到的内漏作为内张力的潜在原因。
